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Our Ask the Doc Q&A series features conversations with world-class physicians from the Grand Rounds expert panel, providing a clinical perspective on the ever-changing health care landscape. In this first edition, meet Dr. Brian Nahed, attending neurosurgeon at Massachusetts General Hospital.

What is your role at Massachusetts General Hospital — can you share a bit about your clinical areas of interest and research?

I’m an attending neurosurgeon, specializing in brain tumors and spinal disorders including glioblastoma, low- and high-grade gliomas, meningiomas, and metastatic brain tumors. I focus on brain tumors of the eloquent cortex — language and motor areas of the brain — which require awake surgery, language and motor mapping, and subcortical stimulation. I also specialize in the use of cutting-edge technology such as intraoperative MRI, CT, and ultrasound to maximize the removal of brain tumors while protecting normal brain function.

My research is focused on developing the first blood-based test for patients with brain tumors. I co-lead a research team that was the first to identify cells circulating in the blood of patients with glioblastoma. We are currently enrolling patients into our research study as we develop this landmark finding into the first blood test to provide patients and their physicians a real-time capability to diagnose and monitor brain tumors.

What inspired you to work with Grand Rounds?

I’m fortunate to operate and practice at Massachusetts General Hospital (MGH) in Boston where my colleagues and I harness phenomenal clinical and research resources to help patients with brain tumors. As a busy referral center, patients are referred to us from local, regional, national and international communities; however, not every patient can come to MGH. Thankfully through Grand Rounds, a patient can easily share their images and medical history from their local setting, and I can then review the clinical information and offer recommendations on next steps. It’s incredibly rewarding to share our expertise with patients so that they can have access to cutting-edge clinical care from anywhere.

At Grand Rounds, we focus on guiding patients to the most qualified physician for their specific conditions, especially considering that 1 in 4 people admits to not knowing how to find the right specialist themselves. In your opinion as a physician, why is access to quality health care and the right expertise so important?

Health care has become more specialized with physicians increasingly focusing on precise areas in their field such as brain tumors. Subsequently, patients from all over the country are referred to high-volume centers — which has resulted in better outcomes for patients, exemplifying the importance of being evaluated by an expert.

Patients often rely on their primary care physician to be referred to these experts. Using Grand Rounds, a patient can be referred to and evaluated by a brain tumor expert regardless of their location — all done seamlessly and electronically. For example, the MGH Brain Tumor Center offers unparalleled clinical care to our patients, focusing on every aspect from surgery to chemotherapy and radiation therapy. Offering this to patients all over the world is our distinct honor, and Grand Rounds allows us to offer our expertise to patients who may not otherwise be able to come to MGH.

If you could change one thing that’s impacting your specialty or the broader health care space, what would it be and why?

The time spent with a patient is increasingly being infringed on by ever-growing paperwork, health care insurance requirements, and growing complexity of the electronic medical record. The understandable excitement to track metrics and determine health care outcomes has in many cases inadvertently led to a deluge of metrics and requirements, detracting from the very goal they are meant to achieve. Health care leaders and physicians need to minimize infringement on the direct delivery of care and create time for the doctor-patient encounter. This would lead to happier patients and doctors, and ultimately, better care in the end.

In your opinion as a physician, what are the important things patients should know about seeking an expert second opinion?

I routinely give second and third opinions for patients with brain tumors and encourage my patients to get second opinions as well. Second opinions can help validate the care a patient is receiving and empower them and their physicians to pursue the planned course of action. In other circumstances, second opinions can offer a different opinion on the diagnosis or treatment and the difference in outcome can be significant — it is worth determining if that is the case.

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